The Pediatric Cardiac Surgery Inquest Report



The operation-August 1

On August 1, Shalynn underwent an aortic coarctectomy with a primary end-to-end anastomosis. In a coarctectomy, the coarctated or narrowed section of the aorta is removed. In what is referred to as a primary end-to-end anastomosis, the remaining sections of the aorta are reconnected. Odim also permanently closed the ductus. Finally, he placed a band around the pulmonary artery. Once this band was in place, Shalynn's blood pressure started to go up, indicating that more blood was going to her body.

The operating team is set out in the accompanying table.

TABLE 7.3: Persons involved in the operation on Shalynn Piller, August 1, 1994
OR team member   Persons involved
Surgeon J. Odim
Surgical assistant N. McEacheran (Resident)
Anaesthetist H. Reimer
Scrub nurse M. Wasney
Circulating nurse E. Frederickson

TABLE: 7.4 Length of phases of the operation on Shalynn Piller, August 1, 1994
Phase of the operation   Time taken
Induction 1 hour 40 minutes
Aortic cross-clamp 25 minutes
Total surgical time 2 hours 30 minutes
Total operating-room time 4 hours 20 minutes

The total induction time was one hour and forty minutes. The total surgical time, from beginning the incision to closure of the incision, was two hours and thirty minutes. The total aortic cross-clamp time was twenty-five minutes. There was no bypass time, as the operation was closed heart surgery.

Shalynn had several episodes of supraventricular tachycardia (SVT, an abnormally fast heart rhythm originating from the atria) during manipulation of the heart. This abnormal rhythm resolved spontaneously. The operation was uneventful, and she was transferred to the NICU in stable condition at 1300 hours.

In his report, Cornel wrote:

The surgery was properly performed and followed the correct decision path. The combination of atrial septal defect, ventricular septal defect, Ebstein's malformation and coarctation is one I have encountered in the past and it is extremely difficult to manage. I do not believe that an attempt to repair all of the lesions would have been more likely to succeed. (Exhibit 353, page 43)

The Pillers had been at the HSC throughout the time of the procedure. At the end of surgery, Odim spoke with them and told them the operation had been successful. The Pillers stayed with their daughter until 2030 hours that evening.

Shalynn Piller - pre-operative heart
Shalynn Piller - pre-operative heart

Diagram 7.4 Shalynn Piller - post-operative heart
Diagram 7.4 Shalynn Piller - post-operative heart
1 - Coarctation repair of aortic arch by end-to-end anastomosis
2 - Ligation and division of patent ductus arteriosius
3 - Pulmonary artery band

Compare pre- and post-operative diagrams side by side



Current Home - Table of Contents - Chapter 7 - The operation-August 1
Next Post-operative course
Previous Pre-operative status
Section 1 Chapter 1 - Introduction to the Issues
  Chapter 2 - Pediatric Cardiac Issues
  Chapter 3 - The Diagnosis of Pediatric Heart Defects and their Surgical Treatment
  Chapter 4 - The Health Sciences Centre
Section 2 Chapter 5 - Pediatric Cardiac Surgery in Winnipeg 1950-1993
  Chapter 6 - The Restart of Pediatric Cardiac Surgery in 1994
January 1, 1994 to May 17, 1994
  Chapter 7 - The Slowdown; May 17 to September 1994
  Chapter 8 - Events Leading to the Suspension of the Program
September 7, 1994 to December 23, 1994
  Chapter 9 - 1995 - The Aftermath of the Shutdown
January to March, 1995
Section 3 Chapter 10 - Findings and Recommendations
Appendix 1 - Glossary of terms used in this report
Appendix 2 - Parties to the Proceedings and counsel
Appendix 3 - List of witnesses and dates of testimony
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